The proposed project represents an effort to use both process and outcome measures of quality of care in a study of ambulatory primary care. Approximately 2,000 episodes of care in two settings--the family practice center at the University of Utah Medical Center and the family practice center at the McKay-Dee Hospital in Ogden--will be studied intensely. Both sites are utilized for the training of family practice residents who provide the bulk of the care. The number of episodes to be studied should provide a reasonable cross-section of problems seen in family practice while at the same time yielding enough high frequency items to be studied specifically for that condition. The study will consist of a prospective portion which focuses on outcomes and a retrospective portion which deals with process measures and costs. Outcome methods will include measures of functional capacity, symptomatology, physiologic status, patient satisfaction, and physician satisfaction. The latter refers to the doctor's retrospective feelings about the outcome obtained. Implicit process measures will utilize record reviews by both peers and faculty using a structured review format which follows the major components of the Problem-Oriented Record. Explicit process reviews will utilize those criteria-based performance standards developed by the Utah Professional Review Organization (UPRO) for ambulatory care. Data will be analyzed within four major categories: 1) factors relating to outcome; 2) a comparison and definition of the relationship between different measures of outcome (including comparisons of actual and predicted outcome and patient and physician satisfaction with outcome); 3) a comparison of outcome measures and the process assessment; and 4) an analysis of the cost effectiveness.